Потребности, ожидания и сомнения у пользователей гормональными контрацептивами

Дикке Г.Б. Потребности, ожидания и сомнения у пользователей гормональными контрацептивами. Гинекология. 2020; 22 (1): e. 33.
DOI: 10.26442/20795696.2020.1.200044

________________________________________________

Dikke G.B. Needs, expectations and doubt users of hormonal contraceptives. Gynecology. 2020; 22 (1): e. 33.
DOI: 10.26442/20795696.2020.1.200044

Читать PDF

Аннотация

Обзор представлен современными публикациями, отражающими важность качественного консультирования пациенток при выборе метода контрацепции и факторы, влияющие на него. Выбор комбинированного орального контрацептива (КОК) определяется потребностью в надежной и безопасной контрацепции, ожиданиями в улучшении качества жизни и сомнениями в отношении частоты побочных эффектов и влияния на репродуктивное и соматическое здоровье. Современный КОК, содержащий эстроген, идентичный натуральному (эстрадиола валерат – Э2В), селективный гестаген (диеногест – ДНГ) с динамическим режимом и укороченным безгормональным интервалом (2 дня) может удовлетворить требования к КОК большинства женщин в возрасте от 18 лет до менопаузы. При его использовании показано улучшение профиля менструальных кровотечений (снижение объема кровопотери на 88% при обильных менструациях) и сексуального функционирования (поддержание либидо, возбуждения и сохранение цикличности сексуального поведения). Э2В/ДНГ оказывает минимальное влияние на метаболизм, продемонстрировал низкий риск тромбоэмболических событий в исследовании реальной практики (скорректированный риск ВТЭ по сравнению с другими КОК составляет 0,4) и низкую частоту отказа от использования по причине побочных явлений (1,7%). Для него характерен баланс эффективности (индекс Перля – 0,42) и удовлетворенности пользователей (78,1–80,2%). КОК с Э2В/ДНГ в режиме 26/2 может удовлетворить требования женщин к контрацепции, что отражается на значимой приверженности ему, т.е. последовательному и правильному применению, и способствует длительному использованию выбранного КОК для поддержания качества жизни женщин на долгие годы.

Ключевые слова: контрацепция, консультирование, эстрадиола валерат, диеногест, эффективность, безопасность.

________________________________________________

The review is presented by modern publications, reflecting the importance of high-quality patient counseling when choosing a method of contraception and the factors that influence it. The choice of combined oral contraceptive (COC) is determined by the need for reliable and safe contraception, expectations for an improved quality of life, and doubts about the frequency of side effects and effects on reproductive and somatic health. Modern COCs containing natural hormone (estradiol valerate), a new gestagen (dienogest) with a dynamic regime and a shortened hormone-free interval (2 days) satisfy the COC requirements of most women aged 18 years to menopause. An improvement in the profile of menstrual bleeding (a decrease in blood loss in 88% of users) and sexual functioning (increased libido, arousal, and maintaining the cyclical nature of sexual behavior) has been shown. Estradiol valerate does not affect metabolism, has a low risk of thromboembolic events (the adjusted risk of VTE compared to other COCs is 0.4) and a low frequency of failure due to side effects (1.7%). This tool is characterized by high efficiency (adjusted Pearl index – 0.42) and user satisfaction (78.1–80.2%). COCs with estradiol valerate/dinogest in 26/2 mode, fully satisfying the requirements of women for contraception, contributes to high adherence to it, that is, consistent and correct use, which contributes to the long-term use of the selected COC and ensures the quality of life of women for many years.

Key words: contraception, counseling, estradiol valerate, dinogest, effectiveness, safety.

Полный текст

Материалы доступны только для специалистов сферы здравоохранения.
Чтобы посмотреть материал полностью Авторизуйтесь или зарегистрируйтесь.

Список литературы

1. Gambera A, Corda F, Papa R et al. Observational, prospective, multicentre study to evaluate the effects of counselling on the choice of combined hormonal contraceptives in Italy – the ECOS (Educational COunselling effectS) study. BMC Womens Health 2015; 15: 69. DOI: 10.1186/s12905-015-0226-x
2. Egarter C, Frey Tirri B et al. Women’s perceptions and reasons for choosing the pill, patch, or ring in the CHOICE study: a cross-sectional survey of contraceptive method selection after counseling. BMC Womens Health 2013; 13: 9. DOI: 10.1186/1472-6874-13-9
3. Дикке Г.Б. Пять шагов к успешной контрацепции. Руководство для врачей. М.: Академия Естествознания, 2017.
[Dikke G.B. Five steps to successful contraception: a guide for doctors. Moscow: Academy of Natural Sciences, 2017 (in Russian).]
4. Сакевич В.И. Аборты в мире: неравномерная динамика и неравный доступ. Демоскоп Weekly. 2018; 773–774. http://demoscope.ru/
[Sakevich V.I. Abortions in the world: uneven dynamics and unequal access. Demoscope Weekly. 2018; 773–774. http://demoscope.ru/ (in Russian).]
5. Дикке Г.Б., Ерофеева Л.В. Контрацепция в современной России: применение и информированность (популяционное исследование). Акушерство и гинекология. 2016; 2: 108–13. DOI: 10.18565/aig.2016.2.108-113
[Dikke G.B., Erofeeva L.V. Contraception in modern Russia: use and awareness (population study). Obstetrics and gynecology/Akusherstvo i ginekologiya. 2016; 2: 108–13. DOI: 10.18565/aig.2016.2.108-113 (in Russian).]
6. FIGO. The global unmet need for modern contraceptives. 26.09.2018. https://www.figo.org
7. Hooper DJ. Attitudes, awareness, compliance and preferences among hormonal contraception users: a global, cross-sectional, self-administered, online survey. Clin Drug Investig 2010; 30: 749–63.
8. Довлетханова Э.Р., Прилепская В.Н. Эстрадиола валерат и диеногест в гормональной контрацепции: приемлемость и эффективность в реальной клинической практике. Мед. совет. 2018: 13: 34–8. DOI: 10.21518/2079-701X-2018-13-34-38
[Dovletkhanova E.R., Prilepskaia V.N. Estradiola valerat i dienogest v gormonal'noi kontratseptsii: priemlemost' i effektivnost' v real'noi klinicheskoi praktike. Med. sovet. 2018: 13: 34–8. DOI: 10.21518/2079-701X-2018-13-34-38 (in Russian).]
9. Ahrendt HJ, Makalová D, Parke S et al. Bleeding pattern and cycle control with an estradiol-based oral contraceptive: a seven-cycle, randomized comparative trial of estradiol valerate/dienogest and ethinyl estradiol/levonorgestrel. Contraception 2009; 80 (5): 436–44. DOI: 10.1016/j.contraception.2009.03.018
10. Fruzzetti F, Paoletti AM, Fidecicchi T et al. Contraception with estradiol valerate and dienogest: adherence to the method. Open Access
J Contracept 2019; 10: 1–6. DOI: 10.2147/OAJC.S204655
11. Fraser IS, Parke S, Mellinger U et al. Effective treatment of heavy and/or prolonged menstrual bleeding without organic cause: pooled analysis of two multinational, randomised, double-blind, placebo-controlled trials of oestradiol valerate and dienogest. Eur J Contracept Reprod Health Care 2011; 16 (4): 258–69. DOI: 10.3109/13625187.2011.591456
12. Briggs P, Serrani M, Vogtländer K, Parke S. Continuation rates, bleeding profile acceptability, and satisfaction of women using an oral contraceptive pill containing estradiol valerate and dienogest versus a progestogen-only pill after switching from an ethinylestradiol-containing pill in a real-life setting: results of the CONTENT study. Int J Womens Health 2016; 8: 477–87. eCollection 2016
13. Premenstrual syndrome: Overview. In: Informed Health Online. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG), 2017. https://www.ncbi.nlm.nih.gov/books/NBK279265/
14. Cooper DB, Adigun R. Oral Contraceptive Pills. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2018. https://www.ncbi.nlm.nih.gov/books/NBK430882//
15. Nappi RE, Nappi G. Neuroendocrine aspects of migraine in women. Gynecol Endocrinol 2012; 28: 37–41. DOI: 10.3109/09513590.2012.651931
16. Mabey Jr RG, Parke S, Mellinger U et al. Hormone withdrawal-associated symptoms: comparison of estradiol valerate/dienogest versus ethinylestradiol/norgestimate. Abstract plus poster presentation at the 60th Annual Clinical Meeting of the American College of Obstetricians and Gynecologists; 2012 May 5–9; San Diego, CA. Eur
J Contracept Reprod Health Care 2013; 18 (4): 274–83. DOI: 10.3109/13625187.2013.785516
17. Jensen JT, Parke S, Mellinger U et al. Hormone withdrawal-associated symptoms: Comparison of oestradiol valerate/dienogest versus ethinylestradiol/norgestimate. Eur J Contracep Reprod Health Care 2013; 18 (4): 274–83. DOI: 10.3109/13625187.2013.785516
18. Macìas G, Merki-Feld GS, Parke S et al. Hormone withdrawal-associated symptoms in women taking combined oral contraceptives: comparison of estradiol valerate/dienogest versus ethinylestradiol/levonorgestrel. Abstract plus poster presentation at the 15th World Congress on Gynecological Endocrinology; 2012 March 7–10; Firenze, Italy.
19. Macìas G, Merki-Feld S, Parke S et al. Effects of a combined oral contraceptive containing oestradiol valerate/dienogest on hormone withdrawal-associated symptoms: Results from the multicentre, randomised, double-blind, active-controlled HARMONY II study. J Obstet Gynaecol 2013; 33: 591–6. DOI: 10.3109/01443615.2013.800851
20. Graziottin A. The shorter, the better: A review of the evidence for a shorter contraceptive hormone-free interval. Eur J Contracept Reprod Health Care 2016; 21 (2): 93–105. DOI: 10.3109/13625187.2015.1077380
21. Grandi G, Xholli A, Napolitano A et al. Prospective measurement of blood pressure and heart rate over 24 h in women using combined oral contraceptives with estradiol. Contraception 2014; 90 (5): 529–34. DOI: 10.1016/j.contraception.2014.05.011
22. Paoletti AM, Lello S, Di Carlo C et al. Effect of Estradiol valerate plus dienogest on body composition of healthy women in the menopausal transition: a prospective one-year evaluation. Gynecol Endocr 2016; 32 (1): 61–4. DOI: 10.3109/09513590.2015.1079175
23. Junge W, Mellinger U, Parke S, Serrani M. Metabolic and haemostatic effects of estradiol valerate/dienogest, a novel oral contraceptive: a randomized, open-label, single-centre study. Clin Drug Investig 2011; 31 (8): 573–84. DOI: 10.2165/11590220-000000000-00000
24. Grandi G, Piacenti I, Volpe A, Cagnacci A. Modification of body composition and metabolism during oral contraceptives containing non-androgenic progestins in association with estradiol or ethinyl estradiol. Gynecol Endocrinol 2014; 30 (9): 676–80. DOI: 10.3109/09513590.2014.922947
25. De Leo V, Fruzzetti F, Musacchio MC et al. Effect of a new oral contraceptive with estradiol valerate/dienogest on carbohydrate metabolism. Contraception 2013; 88 (3): 364–8. DOI: 10.1016/j.contraception.2012.09.003
26. Dinger J, Do Minh T, Heinemann K. Impact of estrogen type on cardiovascular safety of combined oral contraceptives. Contraception 2016; 94 (4): 328–39. DOI: 0.1016/j.contraception.2016.06.010
27. Wallwiener CW, Wallwiener L-M, Seeger H et al. Are hormonal components of oral contraceptives associated with impaired female sexual function? A questionnaire-based online survey of medical students in Germany, Austria, and Switzerland. Arch Gynecol Obstet 2015; 292 (4): 883–90. DOI: 10.1007/s00404-015-3726-x
28. Pastor Z, Holla K, Chmel R. The influence of combined oral contraceptives on female sexual desire: a systematic review. Eur J Contracept Reprod Health Care 2013; 18 (1): 27–43. DOI: 10.3109/13625187.2012.728643
29. Casado-Espada NM, de Alarcón R, de la Iglesia-Larrad JI et al. Hormonal Contraceptives, Female Sexual Dysfunction, and Managing Strategies: A Review. J Clin Med 2019; 8 (6): 908. DOI: 10.3390/jcm8060908
30. Higgins JA, Smith NK. The Sexual Acceptability of Contraception: Reviewing the Literature and Building a New Concept. J Sex Res 2016; 53 (4–5): 417–56. DOI: 10.1080/00224499.2015.1134425
31. Davis SR, Bitzer J, Giraldi A et al. Change to either a nonandrogenic or androgenic progestin-containing oral contraceptive preparation is associated with improved sexual function in women with oral contraceptive-associated sexual dysfunction. J Sex Med 2013; 10: 3069–79. DOI: 10.1111/jsm.12310
32. Caruso S, Agnello C, Romano M et al. Preliminary study on the effect of four-phasic estradiol valerate and dienogest (E2V/DNG) oral contraceptive on the quality of sexual life. J Sex Med 2011; 8 (10): 2841–50. DOI: 10.1111/j.1743-6109.2011.02409.x
33. De Seta F, Restaino S, Banco R et al. Effects of estroprogestins containing natural estrogen on vaginal flora. Gynecol Endocrinol 2014; 30 (11): 830–5. DOI: 10.3109/09513590.2014.936847
34. Nelson A, Parke S, Makalova D et al. Efficacy and bleeding profile of a combined oral contraceptive containing oestradiol valerate/dienogest: a pooled analysis of three studies conducted in North America and Europe. Eur J Contracept Reprod Health Care 2013; 18 (4): 264–73. DOI: 10.3109/13625187.2013.780202
35. Barnett C, Dinger J, Minh TD, Heinemann K. Unintended pregnancy rates differ according to combined oral contraceptive – results from the INAS-SCORE study. Eur J Contracept Reprod Health Care 2019; 24 (4): 247–50. DOI: 10.1080/13625187.2019.1629412

________________________________________________

1. Gambera A, Corda F, Papa R et al. Observational, prospective, multicentre study to evaluate the effects of counselling on the choice of combined hormonal contraceptives in Italy – the ECOS (Educational COunselling effectS) study. BMC Womens Health 2015; 15: 69. DOI: 10.1186/s12905-015-0226-x
2. Egarter C, Frey Tirri B et al. Women’s perceptions and reasons for choosing the pill, patch, or ring in the CHOICE study: a cross-sectional survey of contraceptive method selection after counseling. BMC Womens Health 2013; 13: 9. DOI: 10.1186/1472-6874-13-9
3. Dikke G.B. Five steps to successful contraception: a guide for doctors. Moscow: Academy of Natural Sciences, 2017 (in Russian).
4. Sakevich V.I. Abortions in the world: uneven dynamics and unequal access. Demoscope Weekly. 2018; 773–774. http://demoscope.ru/ (in Russian).
5. Dikke G.B., Erofeeva L.V. Contraception in modern Russia: use and awareness (population study). Obstetrics and gynecology/Akusherstvo i ginekologiya. 2016; 2: 108–13. DOI: 10.18565/aig.2016.2.108-113 (in Russian).
6. FIGO. The global unmet need for modern contraceptives. 26.09.2018. https://www.figo.org
7. Hooper DJ. Attitudes, awareness, compliance and preferences among hormonal contraception users: a global, cross-sectional, self-administered, online survey. Clin Drug Investig 2010; 30: 749–63.
8. Dovletkhanova E.R., Prilepskaia V.N. Estradiola valerat i dienogest v gormonal'noi kontratseptsii: priemlemost' i effektivnost' v real'noi klinicheskoi praktike. Med. sovet. 2018: 13: 34–8. DOI: 10.21518/2079-701X-2018-13-34-38 (in Russian).
9. Ahrendt HJ, Makalová D, Parke S et al. Bleeding pattern and cycle control with an estradiol-based oral contraceptive: a seven-cycle, randomized comparative trial of estradiol valerate/dienogest and ethinyl estradiol/levonorgestrel. Contraception 2009; 80 (5): 436–44. DOI: 10.1016/j.contraception.2009.03.018
10. Fruzzetti F, Paoletti AM, Fidecicchi T et al. Contraception with estradiol valerate and dienogest: adherence to the method. Open Access
J Contracept 2019; 10: 1–6. DOI: 10.2147/OAJC.S204655
11. Fraser IS, Parke S, Mellinger U et al. Effective treatment of heavy and/or prolonged menstrual bleeding without organic cause: pooled analysis of two multinational, randomised, double-blind, placebo-controlled trials of oestradiol valerate and dienogest. Eur J Contracept Reprod Health Care 2011; 16 (4): 258–69. DOI: 10.3109/13625187.2011.591456
12. Briggs P, Serrani M, Vogtländer K, Parke S. Continuation rates, bleeding profile acceptability, and satisfaction of women using an oral contraceptive pill containing estradiol valerate and dienogest versus a progestogen-only pill after switching from an ethinylestradiol-containing pill in a real-life setting: results of the CONTENT study. Int J Womens Health 2016; 8: 477–87. eCollection 2016
13. Premenstrual syndrome: Overview. In: Informed Health Online. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG), 2017. https://www.ncbi.nlm.nih.gov/books/NBK279265/
14. Cooper DB, Adigun R. Oral Contraceptive Pills. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2018. https://www.ncbi.nlm.nih.gov/books/NBK430882//
15. Nappi RE, Nappi G. Neuroendocrine aspects of migraine in women. Gynecol Endocrinol 2012; 28: 37–41. DOI: 10.3109/09513590.2012.651931
16. Mabey Jr RG, Parke S, Mellinger U et al. Hormone withdrawal-associated symptoms: comparison of estradiol valerate/dienogest versus ethinylestradiol/norgestimate. Abstract plus poster presentation at the 60th Annual Clinical Meeting of the American College of Obstetricians and Gynecologists; 2012 May 5–9; San Diego, CA. Eur
J Contracept Reprod Health Care 2013; 18 (4): 274–83. DOI: 10.3109/13625187.2013.785516
17. Jensen JT, Parke S, Mellinger U et al. Hormone withdrawal-associated symptoms: Comparison of oestradiol valerate/dienogest versus ethinylestradiol/norgestimate. Eur J Contracep Reprod Health Care 2013; 18 (4): 274–83. DOI: 10.3109/13625187.2013.785516
18. Macìas G, Merki-Feld GS, Parke S et al. Hormone withdrawal-associated symptoms in women taking combined oral contraceptives: comparison of estradiol valerate/dienogest versus ethinylestradiol/levonorgestrel. Abstract plus poster presentation at the 15th World Congress on Gynecological Endocrinology; 2012 March 7–10; Firenze, Italy.
19. Macìas G, Merki-Feld S, Parke S et al. Effects of a combined oral contraceptive containing oestradiol valerate/dienogest on hormone withdrawal-associated symptoms: Results from the multicentre, randomised, double-blind, active-controlled HARMONY II study. J Obstet Gynaecol 2013; 33: 591–6. DOI: 10.3109/01443615.2013.800851
20. Graziottin A. The shorter, the better: A review of the evidence for a shorter contraceptive hormone-free interval. Eur J Contracept Reprod Health Care 2016; 21 (2): 93–105. DOI: 10.3109/13625187.2015.1077380
21. Grandi G, Xholli A, Napolitano A et al. Prospective measurement of blood pressure and heart rate over 24 h in women using combined oral contraceptives with estradiol. Contraception 2014; 90 (5): 529–34. DOI: 10.1016/j.contraception.2014.05.011
22. Paoletti AM, Lello S, Di Carlo C et al. Effect of Estradiol valerate plus dienogest on body composition of healthy women in the menopausal transition: a prospective one-year evaluation. Gynecol Endocr 2016; 32 (1): 61–4. DOI: 10.3109/09513590.2015.1079175
23. Junge W, Mellinger U, Parke S, Serrani M. Metabolic and haemostatic effects of estradiol valerate/dienogest, a novel oral contraceptive: a randomized, open-label, single-centre study. Clin Drug Investig 2011; 31 (8): 573–84. DOI: 10.2165/11590220-000000000-00000
24. Grandi G, Piacenti I, Volpe A, Cagnacci A. Modification of body composition and metabolism during oral contraceptives containing non-androgenic progestins in association with estradiol or ethinyl estradiol. Gynecol Endocrinol 2014; 30 (9): 676–80. DOI: 10.3109/09513590.2014.922947
25. De Leo V, Fruzzetti F, Musacchio MC et al. Effect of a new oral contraceptive with estradiol valerate/dienogest on carbohydrate metabolism. Contraception 2013; 88 (3): 364–8. DOI: 10.1016/j.contraception.2012.09.003
26. Dinger J, Do Minh T, Heinemann K. Impact of estrogen type on cardiovascular safety of combined oral contraceptives. Contraception 2016; 94 (4): 328–39. DOI: 0.1016/j.contraception.2016.06.010
27. Wallwiener CW, Wallwiener L-M, Seeger H et al. Are hormonal components of oral contraceptives associated with impaired female sexual function? A questionnaire-based online survey of medical students in Germany, Austria, and Switzerland. Arch Gynecol Obstet 2015; 292 (4): 883–90. DOI: 10.1007/s00404-015-3726-x
28. Pastor Z, Holla K, Chmel R. The influence of combined oral contraceptives on female sexual desire: a systematic review. Eur J Contracept Reprod Health Care 2013; 18 (1): 27–43. DOI: 10.3109/13625187.2012.728643
29. Casado-Espada NM, de Alarcón R, de la Iglesia-Larrad JI et al. Hormonal Contraceptives, Female Sexual Dysfunction, and Managing Strategies: A Review. J Clin Med 2019; 8 (6): 908. DOI: 10.3390/jcm8060908
30. Higgins JA, Smith NK. The Sexual Acceptability of Contraception: Reviewing the Literature and Building a New Concept. J Sex Res 2016; 53 (4–5): 417–56. DOI: 10.1080/00224499.2015.1134425
31. Davis SR, Bitzer J, Giraldi A et al. Change to either a nonandrogenic or androgenic progestin-containing oral contraceptive preparation is associated with improved sexual function in women with oral contraceptive-associated sexual dysfunction. J Sex Med 2013; 10: 3069–79. DOI: 10.1111/jsm.12310
32. Caruso S, Agnello C, Romano M et al. Preliminary study on the effect of four-phasic estradiol valerate and dienogest (E2V/DNG) oral contraceptive on the quality of sexual life. J Sex Med 2011; 8 (10): 2841–50. DOI: 10.1111/j.1743-6109.2011.02409.x
33. De Seta F, Restaino S, Banco R et al. Effects of estroprogestins containing natural estrogen on vaginal flora. Gynecol Endocrinol 2014; 30 (11): 830–5. DOI: 10.3109/09513590.2014.936847
34. Nelson A, Parke S, Makalova D et al. Efficacy and bleeding profile of a combined oral contraceptive containing oestradiol valerate/dienogest: a pooled analysis of three studies conducted in North America and Europe. Eur J Contracept Reprod Health Care 2013; 18 (4): 264–73. DOI: 10.3109/13625187.2013.780202
35. Barnett C, Dinger J, Minh TD, Heinemann K. Unintended pregnancy rates differ according to combined oral contraceptive – results from the INAS-SCORE study. Eur J Contracept Reprod Health Care 2019; 24 (4): 247–50. DOI: 10.1080/13625187.2019.1629412

Авторы

Г.Б. Дикке*

ЧОУ ДПО «Академия медицинского образования им. Ф.И. Иноземцева», Санкт-Петербург, Россия
*galadikke@yandex.ru

________________________________________________

Galina B. Dikke*

Inozemtsev Academy of Medical Education, Saint Petersburg, Russia
*galadikke@yandex.ru

Назад к списку

Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.